Acute Neuro & Neuroimmune Disorders

1. Best Intervention to Reduce VTE (Venous Thromboembolism)

Venous Thromboembolism = DVT + PE

Best nursing interventions:

• Early mobilization — ASAP post-op or post-injury

• VTE prophylaxis within 72 hours (unless contraindicated)

  • e.g., Low molecular weight heparin (LMWH)

• Sequential Compression Devices (SCDs)

• Hydration

• Monitor for calf pain, redness, or swelling

📌 SCI patients are at high risk due to immobility. VTE prophylaxis is a priority.

🔹 2. How to Calculate Cerebral Perfusion Pressure (CPP)

CPP = MAP - ICP

CPP → Pressure needed to ensure blood flow to the brain.

• MAP (Mean Arterial Pressure) = (SBP+2×DBP)/3

• ICP (Intracranial Pressure) = pressure inside skull

🧮 Example:
If MAP = 90 mmHg and ICP = 15 mmHg
→ CPP = 90 - 15 = 75 mmHg

✅ Normal CPP = 60–100 mmHg

• < 50 mmHg → ischemia, neuronal death

• < 30 mmHg → ischemia, incompatible with life

🔹 3. Nursing Interventions to Optimize ICP

Goal: Reduce pressure, promote perfusion, and prevent herniation

Key Interventions:

• HOB at 30° (not flat)

• Maintain neutral head position

• Prevent hypoxia/hypercapnia (e.g., adequate oxygenation)

• Avoid suctioning unless necessary

• Minimize stimuli (lights, noise, clustering care)

• Administer:

  • Mannitol or Hypertonic Saline to reduce ICP

    • Hypertonic saline has a high concentration of sodium to draw water out of the brain tissue and into the blood vessels.

  • Antipyretics to prevent fever

  • Sedatives/analgesics to reduce agitation

• Prevent seizures with anticonvulsants

⛔ Avoid lumbar puncture with high ICP → risk of herniation

🔹 4. Normal Range for ICP

✅ Normal ICP: 5–15 mmHg

• Mildly elevated: 16–20 mmHg

• Moderate: 21–30 mmHg

• Severe: 31–40 mmHg

• Critical: >40 mmHg

📌 Cushing’s Triad = late sign of high ICP = MEDICAL EMERGENCY!

• Bradycardia

• Hypertension with widened pulse pressure

• Irregular respirations

ICP → Pressure within the skull occupied by the brain, blood, and CSF.

• Monroe-Kellie doctrine state that the three components must remain at a constant volume; if one component increases, another must decrease to maintain ICP (skull cannot expand).

  • Brain herniation occurs from too much pressure (brain tissue shifts abnormally and compresses vital structures).

🔹 5. IVIG in Guillain-Barré Syndrome (GBS)

IVIG = Intravenous Immunoglobulin

Purpose:

• Modulates/controls immune response to reduce severity of GBS.

• Blocks harmful antibodies attacking nerves

• Most effective within 2 weeks of symptom onset

• Given over 5 days

📌 Used to speed recovery and reduce severity.

🔹 6. Guillain-Barré Syndrome Overview

Autoimmune demyelinating condition (immune system mistakenly attacks the nerves).

Progression:

• Ascending → weakness starts in lower extremities, moves upward

• Symmetrical, rapidly progressive weakness

• Max weakness in 4 weeks

Clinical Manifestations:

• Weakness

• Parathesis + pain

• Hypotonia (AKA muscle floppiness)

• Absent/depressed DTR

• Muscle cramps/aches

Major risks:

• Respiratory failure (watch for diaphragm paralysis)

• Autonomic dysfunction (BP swings, dysrhythmias)

• Immobility (muscle atrophy, VTE)

🧬 Often preceded by GI or respiratory infection

🔹 7. Cauda Equina Syndrome

🦴 Compression of lumbosacral nerve roots (cauda equina)

Symptoms (red flags):

• Asymmetric leg weakness

• Flaccid paralysis of legs

• Loss of sensation in "saddle" area (buttocks, inner thighs)

• Bladder & bowel dysfunction (retention or incontinence)

• Severe low back pain with radiculopathy

📌 MEDICAL EMERGENCY! Requires surgical decompression.

🔹 8. What is Not a Cause of Autonomic Dysreflexia?

Autonomic Dysreflexia = Life-threatening emergency in SCI at T6 or above

Characterized by severely high BP and bradycardia from overreacting to stimuli.

✅ Causes (stimuli below T6):

• Full bladder (most common)

• Impaction

• Tight clothing

• Pressure ulcers, ingrown toenails

❌ Not a cause:

• Hypoglycemia

• Anxiety

• Fever (not a direct cause)

📌 Look for sudden headache, HTN, bradycardia, sweating above injury, flushed face and upper chest above injury, and nasal congestion.